Regional IFE workshop in Bali

One hundred and twelve participants from 16 countries and special territories, together with regional and international representatives of United Nations (UN) agencies, non-governmental organisations (NGOs) and infant and young child feeding experts, met in Bali, Indonesia from 10-13 March 2008 to reach consensus on how to protect and support Infant and Young Child Feeding in Emergencies (IFE) in the region. The particular focus was on emergency preparedness and the early humanitarian response on IFE.

The workshop was organised by the Emergency Nutrition Network (ENN) as coordinator of the IFE Core Group - an established interagency collaboration developing policy guidance and building capacity on IFE since 19992. The workshop was funded by the Inter- Agency Standing Committee (IASC) Nutrition Cluster and IBFAN-GIFA3.

The aims of the meeting were to orientate participants on relevant policy, guidance, key issues and initiatives in IFE, to identify key constraints to appropriate IFE, and to establish strategic directions and practical steps to address these, at country, regional and international levels.

The four day workshop comprised two days of presentations and discussions that culminated on Day 3 in a series of thematic and country working groups. This was followed by a capacity building workshop on Day 4 that focused upon training needs of frontline workers in a variety of scenarios.

The workshop opened with a reminder of our responsibilities towards infants and young children in emergencies4. Subsequent presentations highlighted global efforts on IFE to improve capacity for a timely and appropriate response. These included the importance of the International Code on Marketing of Breastmilk Substitutes (International Code) in protecting infants and caregivers from inappropriate marketing of breastmilk substitutes including during emergencies, an orientation on key provisions of the Operational Guidance on IFE5, and the work of the IASC Nutrition Cluster to improve coordination, as well as timely and appropriate interventions, in IFE.

Country situations

A country/territory grid prepared by participants
on Day 1 to map areas of concern
in IFE. Red reflects problem areas, yellow
reflects medium problems, green reflects
'no problem'. Each country/territory only
had a limited number of 'big problem' and
'small/medium problem' cards, in order to
prioritize the areas of main concern.

A participatory country situation analysis and country presentations on Days 1 and 2 clearly indicated that the current situation with regards to IFE in the region is far from optimal. Most countries reported poor coordination of the emergency response on IFE, lack of national policies that specifically deal with IFE, and low capacity. These issues all contribute to a general lack of services to protect and support breastfeeding, to manage artificial feeding and to have appropriate complementary feeding in emergencies.

IFE often reflects poor prior infant and young child feeding (IYCF) in non-emergencies, making it especially difficult to ameliorate IYCF during emergencies. Much work, therefore, needs to be done to improve IYCF in general (in preparedness). It was noted that emergencies may actually provide an opportunity to redouble, and even accelerate, country efforts to optomise IYCF practices.

Donations of BMS

Almost all countries at the workshop had experienced receiving large, unsolicited donations of infant formula and other milk products during emergencies. Indonesia presented data collected during the 2006 earthquake response showing clear correlations between receipts of donations, their use, and increased diarrhoea incidence in infants and young children6. Given the importance of donations as a regional issue, workshop participants especially appreciated the story of the Philippines' success in winning a court case (2006) to uphold national legislation that allowed adherence to the principles of the International Code7.

The media and communication

Many misconceptions around infant feeding in emergencies are perpetuated by the media, which often highlights or initiates calls for donations and often report mothers cannot breastfeed due to stress. An analysis of media coverage during the Bangladesh emergency highlighted the nature of such coverage and the importance of good communications in emergencies. Discussions explored how to improve engagement with the media, communicate key IFE messages and in particular, the risks associated with artificial feeding.

Working Groups

Each thematic working group covered one of the six main components of the Operational Guidance on IFE - i) Policies, ii) Capacity Building, iii) Coordination, iv) Assessment and Monitoring, v) Protection, Promotion and Support of Optimal IYCF and vi) Minimising the Risks of Artificial Feeding. Some key discussion areas were:

How best to undertake timely and appropriate assessments of IYCF practices in an emergency.

The lack of guidance and programmatic experience on interventions to support artificial feeding in emergencies, in particular on integrated programming that supports both breastfed and non-breastfed infants in an emergency context.

The AFASS (Acceptable, Feasible, Affordable, Sustainable, Safe) criteria, developed in the context of HIV and infant feeding, were considered relevant to any artificial feeding in an emergency context and their application was explored.

Complementary feeding in emergencies was emphasised as an area of great concern. The increasing use of Ready to Use Therapeutic Foods (RUTF) in the prevention as well as treatment of acute malnutrition raises issues over sustainability, their appropriateness for use as a complementary food, and the need to balance these innovations with more food based/holistic approaches to feeding infants and young children.

The way forward

On Day 3, country/regional/global working groups produced detailed action plans. The regional/global working group highlighted the poor attendance by invited international and regional bilateral donors at the workshop. Key actions were reflected in a Pledge for Action by participants, and a model Joint Statement on IFE to call for appropriate IYCF support during an emergency collectively produced by the participants by the end of Day 3.

This workshop was well-received and wellattended and the result of strong collaboration between many UN and NGO partners and their national counterparts. A post-meeting evaluation is currently underway. It is hoped that this workshop will be the first in a series of regional workshops to raise awareness and build capacity on IFE.

The full meeting report 'Making it Happen', the model Joint Statement on IFE, the Pledge for Action and all presentations are available on the ENN website, www.ennonline.net/ife in the IFE Resource Library or request from ENN, email: marie@ennonline.net

4Reflected in the UNICEF/WHO Global Strategy on Infant and Young Child Feeding, in Article 24 of the Convention on the Rights of the Child and the Call for Action contained in the Innocenti Declaration 2005 on Infant and Young Child Feeding